Spartan Race

Wednesday, December 9, 2009

I’m going to start off with a disclaimer here, because this is a controversial subject. I’m not necessarily advocating for or against alcohol consumption. I’m just laying out some interesting facts as reported in the medical literature. It’s not meant to be an exhaustive review, just a quick little blog entry to generate discussion, however, all the literature I am mentioning is readily available, so you can go check it out for yourself if you like.Most of us have heard something about wine (usually red in particular) being good for cardiovascular health, but aren’t really sure what that means. If you bring up this up in a group of physicians, you will likely get very polarized opinions - a bunch will claim that wine is the greatest thing since sliced bread, and a bunch will claim that alcohol has such a negative impact on society overall that any health benefits are automatically overwhelmed by the bad stuff. I think both sides have some merit to them. Alcoholism is a very real and devastating disease. I’ve taken care of enough people with end stage liver disease and alcoholic dementia to know that it’s a long, protracted, horrible way to die and we’re all aware of the tragedies that occur when people drink and drive. Clearly, you can have too much of a good thing, even if it really is a good thing.But what about alcohol (particularly wine) in moderation? What does that do? Well, back in 1979 a guy named St. Leger wrote an article that pointed out an inverse relationship between red wine consumption and death from cardiovascular disease. In a slightly morphed way, this later became known as the “French Paradox”. In other words, why can the French smoke and eat really fatty foods without having an unbelievable amount of heart disease? Well, some other studies showed that heart disease was lowest in the regions that drank the most red wine and highest in the regions that drank the least. This prompted a whole bunch of studies on overall mortality (read death rate) and alcohol consumption. As it turns out both retrospective and prospective studies have showed decrease in risk of death with moderate consumption of wine (1 to 2 drinks a day). In some cases, the risk has been shown to be decreased by as much as a third. A similar case has been made for beer, though the risk seems to have been decreased by about 20% in that situation (again, moderate consumption 1-2 drinks a day). Drink more than that and in a lot of the studies the risk of something bad happening actually goes up.So is it the wine, or something in the wine, that provides the benefit – in other words, can we purify something out of the wine and have the benefits without the risk? Well, in one study that I probably would have volunteered for, the vasodilatory effect of Chateauneuf du Pape, Reisling, and straight up ethanol were compared. It seems CDP opens up blood vessels pretty well, where as ethanol and reisling don’t. Studies like this prompted researchers to postulate that there was something else in the Rhone wine that was beneficial. The phenolic compounds in the wine were seen as a likely source – particularly something called resveratrol. A lot of these compounds are potent antioxidants and also seem to increase nitric oxide synthase (which leads to vasodialation). So do you just take the resveratrol? Maybe, it certainly doesn’t have the other negative issues associated with it that ethanol does (liver failure, alcoholism, etc), but there does seem to be at least some intrinsic benefit from the ethanol. Ethanol increases HDL (which is good) and decreases platelet deposition (which is good if you have a ruptured atherosclerotic plaque, but bad if you cut yourself). Oddly enough, red wine also seems to increase the level of Omega 3 fatty acids in the blood, which is a good thing in and of itself.So should you drink red wine in moderation or not? That’s for you to decide. Most of the literature recommends cutting back or quitting if you are a heavy drinker and not increasing your consumption if you are a light or non-drinker. As for me, I like Petite Sirah and Zinfindal and Cab Franc and even Pinotage and don’t really need an excuse to drink them.

3 comments:

i have an alternate philosophy as well that speaks to the intangible attributes of red wine drinkers...the ability to relax, enjoy life in small ways and laugh must play some role in good physiological health no?

You make a good point, and a similar theory has been proposed in the literature. That one says basically that red wine drinkers are more likely to be physcially active, have a healthy diet, not smoke, etc. Hard liquor drinker are more likely to be "hard livers" no pun intended, and not take care of themselves and die earlier. The counter arguement to this is the French Paradox.

Did you know that your 6th grade English teacher is an oenophile and a great fan of Petite Syrah? She is a die-hard David Bruce- for-value fan for the American iteration of this divine nectar. Did you also know her dad is a Texas award-winning vintner? In addition, do you know how fabulous it's been for her to read of your life through your writing? Well, done, sir!

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I run mostly half marathons, with an occasional full marathon or 10K thrown in for fun. Lately, I've started hitting a bunch of Obstacle Races, which has given me something new to chew on at this point. I've gotten kind of addicted to them.

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Medicine

I'm a hospitalist and lipidologist. I function as both an academic attending for residents and medical students and a private hospitalist/nocturnist. My interests include medical student, resident, and physician assistant education as well as lipid disorders.